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ALL / Endocrinology

Subclinical hypothyroidism

Subclinical hypothyroidism

Basics
  • TSH raised but T3, T4 normal
  • no obvious symptoms

Significance
  • risk of progressing to overt hypothyroidism is 2-5% per year (higher in men)
  • risk increased by the presence of thyroid autoantibodies

Management

Not all patients require treatment. NICE have produced guidelines. Note that not all patients will fall within the age boundaries given and hence these are guidelines in the broader sense.

TSH is > 10mU/L and the free thyroxine level is within the normal range
  • consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range
  • if < 65 years consider offering a 6-month trial of levothyroxine if:
    • the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
    • there are symptoms of hypothyroidism
  • in older people (especially those aged over 80 years) follow a 'watch and wait' strategy is often used
  • if asymptomatic people, observe and repeat thyroid function in 6 months
+PassMedicine Notes
Basics
  • TSH raised but T3, T4 normal
  • no obvious symptoms
Significance
  • risk of progressing to overt hypothyroidism is 2-5% per year (higher in men)
  • risk increased by the presence of thyroid autoantibodies

Management

Not all patients require treatment. NICE have produced guidelines. Note that not all patients will fall within the age boundaries given and hence these are guidelines in the broader sense.

TSH is > 10mU/L and the free thyroxine level is within the normal range
  • consider offering levothyroxine if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart
TSH is between 5.5 - 10mU/L and the free thyroxine level is within the normal range
  • if < 65 years consider offering a 6-month trial of levothyroxine if:
    • the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
    • there are symptoms of hypothyroidism
  • in older people (especially those aged over 80 years) follow a 'watch and wait' strategy is often used
  • if asymptomatic people, observe and repeat thyroid function in 6 months


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